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RestrictiveAnorexia Nervosa is the individual suffering from restrictive anorexia is often perceived as highly self-disciplined. They restrict the quantity of food, calories and often high fat or high sugar foods. They consume far fewer calories than are needed to maintain a healthy weight. This is a heartbreaking form of self-starvation.

Anorexia nervosa (AN) is classically defined as a condition in which an abnormally low body weight is associated with an intense fear of gaining weight and distorted cognitions regarding weight, shape, and drive for thinness. This article reviews recent evidence from physiology, genetics, epigenetics, and brain imaging which allow considering AN as an abnormality of reward pathways or an attempt to preserve mental homeostasis. Special emphasis is put on ghrelin-resistance and the importance of orexigenic peptides of the lateral hypothalamus, the gut microbiota and a dysimmune disorder of neuropeptide signaling. Physiological processes, secondary to underlying, and premorbid vulnerability factors—the “pondero-nutritional-feeding basements”- are also discussed.

Anorexia is a psychological and potentially life-threatening eating disorder. Those suffering from this eating disorder are typically suffering from an extremely low body weight relative to their height and body type.It is an eating disorder characterized by low weight, fear of gaining weight, and a strong desire to be thin, resulting in food restriction.Many people with anorexia see themselves as over weight even though they are in fact underweight.If asked they usually deny they have a problem with low weight.Often they weigh themselves frequently, eat only small amounts, and only eat certain foods.Some will exercise excessively, force themselves to vomit, or use laxatives to produce weight loss.

Types of Anorexia Nervosa

There are two common types of anorexia, which are as follows:

Binge/Purge Type – The person struggling with this type of eating disorder will often purge after eating. This alleviates the fear of gaining weight and offsets some of the guilt of having ingested forbidden, or highly restricted food. The compensatory purge behavior by the individual with Binge/Purge Type anorexia may purge by exercising excessively, vomiting or abusing laxatives.

Restrictive – The individual suffering from restrictive anorexia is often perceived as highly self-disciplined. They restrict the quantity of food, calories and often high fat or high sugar foods. They consume far fewer calories than are needed to maintain a healthy weight. This is a heartbreaking form of self-starvation.

Causes of Restrictive Anorexia Nervosa

Genetics – Changes in specific genes may put certain people at higher risk of anorexia. Those with a first-degree relative — a parent, sibling or child — who had the disorder have a much higher risk of anorexia.

Dieting and starvation – Dieting is a risk factor for developing an eating disorder. There is strong evidence that many of the symptoms of anorexia are actually symptoms of starvation. Starvation affects the brain and influences mood changes, rigidity in thinking, anxiety and reduction in appetite. Starvation and weight loss may change the way the brain works in vulnerable individuals, which may perpetuate restrictive eating behaviors and make it difficult to return to normal eating habits.

Transitions – Whether it’s a new school, home or job; a relationship breakup; or the death or illness of a loved one, change can bring emotional stress and increase the risk of anorexia.

Biological – Although it’s not yet clear which genes are involved, there may be genetic changes that make some people at higher risk of developing anorexia. Some people may have a genetic tendency toward perfectionism, sensitivity and perseverance — all traits associated with anorexia.

Psychological – Some people with anorexia may have obsessive-compulsive personality traits that make it easier to stick to strict diets and forgo food despite being hungry. They may have an extreme drive for perfectionism, which causes them to think they’re never thin enough. And they may have high levels of anxiety and engage in restrictive eating to reduce it.

Environmental – Modern Western culture emphasizes thinness. Success and worth are often equated with being thin. Peer pressure may help fuel the desire to be thin, particularly among young girls.

The effects of the thinness culture in media, that constantly reinforce thin people as ideal stereotypes

Professions and careers that promote being thin and weight loss, such as ballet and modeling

Family and childhood traumas: childhood sexual abuse, severe trauma

Peer pressure among friends and co-workers to be thin or be sexy.

Irregular hormone functions

Genetics (the tie between anorexia and one’s genes is still being heavily researched, but we know that genetics is a part of the story).

Other drugs may be used to intentionally cause anorexia in order to help a patient preoperative fasting prior to general anesthesia. It is important to avoid food before surgery to mitigate the risk of pulmonary aspiration, which can be fatal.

Opiates (such as morphine, heroin, oxycodone, etc.) act upon the digestive system and can reduce the physical sensation of hunger in the same way that they reduce physical sensations of pain. They also frequently cause delayed gastric emptying (gastroparesis) and can sometimes lead to changes in metabolism with long-term use.

Fear of even the slightest weight gain; taking all precautionary measures to avoid weight gain or becoming “overweight”.

Rapid, continuous weight loss.

Lanugo: soft, fine hair growing over the face and body.

An obsession with counting calories and monitoring fat contents of food.

Preoccupation with food, recipes, or cooking; may cook elaborate dinners for others, but not eat the food themselves or consume a very small portion.

Food restrictions despite being underweight or at a healthy weight.

Food rituals, such as cutting food into tiny pieces, refusing to eat around others and hiding or discarding of food.

Purging: May use laxatives, diet pills, ipecac syrup, or water pills to flush food out of their system after eating or may engage in self-induced vomiting though this is a more common symptom of bulimia.

Excessive exercise including micro-exercising, for example making small persistent movements of fingers or toes.

Perception of self as overweight, in contradiction to an underweight reality.

Intolerance to cold and frequent complaints of being cold; body temperature may lower (hypothermia) in an effort to conserve energy due to malnutrition.

Diagnosis of Restrictive Anorexia Nervosa

DSM-5

Anorexia nervosa is classified under the Feeding and Eating Disorders in the latest revision of the Diagnostic and Statistical Manual of Mental Disorders (DSM 5).

Relative to the previous version of the DSM (DSM-IV-TR), the 2013 revision (DSM5) reflects changes in the criteria for anorexia nervosa, most notably that of the amenorrhea criterion being removed.

Subtypes

There are two subtypes of AN

Binge-eating/purging type – the individual utilizes binge eating or displays purging behavior as a means for losing weight.It is different from bulimia nervosa in terms of the individual’s weight. An individual with binge-eating/purging type anorexia can maintain a healthy or normal weight, but is usually significantly underweight. People with bulimia nervosa on the other hand can sometimes be overweight.

Restricting type – the individual uses restricting food intake, fasting, diet pills, or exercise as a means for losing weight; they may exercise excessively to keep off weight or prevent weight gain, and some individuals eat only enough to stay alive.

Levels of severity

Body mass index (BMI) is used by the DSM-5 as an indicator of the level of severity of anorexia nervosa. The DSM-5 states these as follows

Mild: BMI of greater than 17

Moderate: BMI of 16–16.99

Severe: BMI of 15–15.99

Extreme: BMI of less than 15

Investigations of Restrictive Anorexia Nervosa

Medical tests to check for signs of physical deterioration in anorexia nervosa may be performed by a general physician or psychiatrist, including:

Complete Blood Count (CBC)– a test of the white blood cells, red blood cells and platelets used to assess the presence of various disorders such as leukocytosis, leukopenia, thrombocytosis and anemia which may result from malnutrition.

Urinalysis– a variety of tests performed on the urine used in the diagnosis of medical disorders, to test for substance abuse, and as an indicator of overall health

Chem-20 – Chem-20 also known as SMA-20 a group of twenty separate chemical tests performed on blood serum. Tests include cholesterol, protein and electrolytes such as potassium, chlorine and sodium and tests specific to liver and kidney function.

Glucose tolerance test – Oral glucose tolerance test (OGTT) used to assess the body’s ability to metabolize glucose. Can be useful in detecting various disorders such as diabetes, an insulinoma, Cushing’s Syndrome, hypoglycemia and polycystic ovary syndrome.

Serum cholinesterase test – a test of liver enzymes (acetylcholinesterase and pseudocholinesterase) useful as a test of liver function and to assess the effects of malnutrition.

Liver Function Test – A series of tests used to assess liver function some of the tests are also used in the assessment of malnutrition, protein deficiency, kidney function, bleeding disorders, and Crohn’s Disease.

Lh response to GnRH – Luteinizing hormone (Lh) response to gonadotropin-releasing hormone (GnRH) Tests the pituitary glands’ response to GnRh a hormone produced in the hypothalamus. Hypogonadism is often seen in anorexia nervosa cases.

Blood urea nitrogen (BUN) test – urea nitrogen is the byproduct of protein metabolism first formed in the liver then removed from the body by the kidneys. The BUN test is primarily used to test kidney function. A low BUN level may indicate the effects of malnutrition.

BUN-to-creatinine ratio – A BUN to creatinine ratio is used to predict various conditions. A high BUN/creatinine ratio can occur in severe hydration, acute kidney failure, congestive heart failure, and intestinal bleeding. A low BUN/creatinine ratio can indicate a low protein diet, celiac disease, rhabdomyolysis, or cirrhosis of the liver.

Treatment of Restrictive Anorexia Nervosa

Acute pharmacologic treatment of anorexia nervosa is rarely required. However, vitamin supplementation with calcium should be started in patients, and although estrogen has no established effect on bone density in patients with anorexia nervosa, estrogen replacement (ie, oral contraceptives) has been recommended for the treatment of osteopenia; the benefits and minimal effective dose of the hormone are being explored.

Types of Psychological Therapy

Various psychological therapies have proven helpful in treating patients with anorexia nervosa, including the following

Psychotherapy

These types of therapy may be beneficial for anorexia:

Family-based therapy – This is the only evidence-based treatment for teenagers with anorexia. Because the teenager with anorexia is unable to make good choices about eating and health while in the grips of this serious condition, this therapy mobilizes parents to help their child with re-feeding and weight restoration until the child can make good choices about health.

Individual therapy – For adults, cognitive behavioral therapy — specifically enhanced cognitive behavioral therapy — has been shown to help. The main goal is to normalize eating patterns and behaviors to support weight gain. The second goal is to help change distorted beliefs and thoughts that maintain restrictive eating.

Group Therapy – Group therapy allows people with anorexia nervosa to interact with others who have the same disorder. But it can sometimes lead to competition to be the thinnest. To avoid that, it’s important that you attend group therapy that is led by a qualified medical professional.

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1 thought on “Restrictive Anorexia Nervosa, Symptoms, Treatment”

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